Hollawell Shane, Baione William
Associate Clinical Professor, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, and Orthopedic Institute of Central Jersey, Manasquan, NJ.
Orthopaedic Surgery Resident, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
J Foot Ankle Surg. 2015 Nov-Dec;54(6):1146-50. doi: 10.1053/j.jfas.2014.09.006. Epub 2014 Dec 2.
More than 20% of acute Achilles tendon injuries are misdiagnosed, leading to chronic or neglected ruptures. Some controversy exists regarding how to best manage an acute Achilles tendon rupture. However, a general consensus has been reached that chronic rupture with ≥3 cm of separation is associated with functional morbidity and, therefore, should be managed operatively. It has been demonstrated that the functional outcomes of surgically treated Achilles ruptures are superior to the nonoperative outcomes in a chronic setting. In the present report, we reviewed 4 patients with chronic Achilles tendon ruptures that were successfully treated with an Achilles tendon interposition allograft and simultaneous augmentation with a xenograft. The median duration of rupture was 11 (range 8 to 16) weeks, the median gap between the proximal and distal segments of the tendon was 4.75 (range 3.5 to 6) cm, and the patients were able to return pain-free to all preinjury activities at a median of 14.5 (range 13.8 to 15.5) weeks, without the need for tendon transfer, lengthening, or additional intervention. The median duration of follow up was 37.25 (range 15.25 to 51.5) months, at which point the mean Foot and Ankle Outcomes Instrument core scale score was 97 ± 1 (mean normative score 53 ± 1), and the Foot and Ankle Outcomes Instrument shoe comfort core scale score was 100 ± 0 (mean normative score 59 ± 0). The combined Achilles allograft plus xenograft augmentation technique appears to be a reasonable option for the surgical treatment of chronic Achilles tendon rupture.
超过20%的急性跟腱损伤被误诊，导致慢性或被忽视的跟腱断裂。关于如何最佳处理急性跟腱断裂存在一些争议。然而，已达成的普遍共识是，分离≥3 cm的慢性跟腱断裂与功能障碍相关，因此应进行手术治疗。已经证明，在慢性情况下，手术治疗跟腱断裂的功能结果优于非手术治疗。在本报告中，我们回顾了4例慢性跟腱断裂患者，他们通过跟腱植入同种异体移植物并同时用异种移植物增强而成功治疗。断裂的中位持续时间为11周（范围8至16周），肌腱近端和远端节段之间的中位间隙为4.75 cm（范围3.5至6 cm），患者能够在中位14.5周（范围13.8至15.5周）时无痛恢复到所有伤前活动，无需进行肌腱转移、延长或额外干预。中位随访持续时间为37.25个月（范围15.25至51.5个月），此时足踝结局工具核心量表平均评分为97±1（平均标准评分为53±1），足踝结局工具鞋舒适度核心量表评分为100±0（平均标准评分为59±0）。联合跟腱同种异体移植物加异种移植物增强技术似乎是慢性跟腱断裂手术治疗的合理选择。
